Suicide attempts in U.S. Army combat arms, special forces and combat medics.
Level 4 - case-series / case-control
Nested case-control study using administrative person-month records.
PubMed 28545424 · doi:10.1186/s12888-017-1350-y
What was done
This retrospective case-control study analyzed administrative person-month records from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) between 2004 and 2009. The sample included active-duty Regular Army enlisted personnel with a medically documented suicide attempt (n = 9,650) and an equal-probability sample of control person-months (n = 153,528). Logistic regression and discrete-time hazard models evaluated associations between military occupational roles—combat arms, special forces, and combat medics—and suicide attempts, adjusting for sociodemographics, service characteristics, and prior mental health diagnoses.
What was found
Compared with all other military occupations, adjusted odds of a suicide attempt were elevated in combat arms (OR = 1.2 [95% CI: 1.1-1.2]) and combat medics (OR = 1.4 [95% CI: 1.3-1.5]), but lower in special forces (OR = 0.3 [95% CI: 0.2-0.5]). Risk was higher for combat arms and combat medics among soldiers who had never deployed (ORs = 1.1-1.5) or were previously deployed (ORs = 1.2-1.3), but not among currently deployed soldiers. Occupational differences were present during the first 10 years of service only; during the first year of service (primarily training), combat medics had higher odds of suicide attempts compared to both combat arms (OR = 1.4 [95% CI: 1.2-1.6]) and other occupations (OR = 1.5 [95% CI: 1.3-1.7]).
Why it matters
The findings indicate that occupational risk profiles for suicide attempts in the military emerge early in service and differ by specialty, with elevated risks in combat medics and combat arms manifesting primarily outside of active deployment. This can guide targeted monitoring and early-career prevention programs.
Limits
The study is restricted to active-duty enlisted Regular Army personnel from 2004 to 2009 and relies on administrative records, missing suicide attempts that were not medically documented. Confounding by unmeasured individual resilience factors, occupational selection mechanisms, or unit-level variables cannot be ruled out.
Cited by
- context The Green Beret community has lost more personnel to suicide than to combat operations since 2001.